| NPI | 1568591048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK A. FERNANDEZ Partner 815-223-9214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036111100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036089936) |
| 208000000X Pediatrics (Licence: IL 036089936) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IL 036089936) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2008-11-20 |